Wednesday, September 19, 2007

Them 3

Ignorance will be no defence... for those in high-risk groups who do not know they are HIV-positiveTan Hui LengYOU never told your sexual partner you were HIV-positive — because you didn't know it yourself. But you will not be able to plead ignorance in the eyes of the law, if you already belong to a certain high-risk group.

The Ministry of Health (MOH) will be amending the Infectious Diseases Act to "clarify that ignorance of one's HIV status will not be a defence for those who engage in high-risk sexual behaviour", said Health Minister Khaw Boon Wan in Parliament yesterday.

In addition, he said in confirmation of earlier signals, voluntary HIV testing will be introduced for adult male inpatients at hospitals later this year.

The law now simply bars a person who knows he has HIV/Aids from having sex with another person, unless that partner is informed beforehand and voluntarily agrees to accept that risk. Anyone who flouts this law can, if convicted, be fined up to $10,000 or jailed for up to two years, or both.

The tweak to the law — first hinted at in 2005 by then-Minister of State for Health, Dr Balaji Sadasivan — comes as grim statistics show that 278 Singaporeans were diagnosed with HIV/Aids in the first eight months of this year. All of last year, 357 were diagnosed.

The latest update brings the total number of known HIV-infected Singaporeans to 3,338. The prevalence of such cases has risen to 0.07 per cent of the resident population aged 15 years and above — up from 0.02 per cent a decade ago.

But given the sparse details available so far, some observers and Aids activists wonder how effective the legislative change would be in helping to bring Singapore's HIV transmission rates down.

Like others, president of the Association of Women for Action & Research Constance Singam wanted to know more. Would HIV testing be made free as a corollary, for instance? "I believe the law ought to protect the innocent victims from the high-risk behaviour of their partners, but I am just not sure how this amendment is going to work," she said.

A spokesman for Action for Aids (Afa) said the group was waiting to hear the Government's stand on protected sex — that is, could a HIV-infected person who "diligently practises safer sex" be prosecuted under the amendments?

Dr Stuart Koe, a trustee of Afa Endowment Fund and CEO of Fridae.com, was concerned such a "blanket law will further stigmatise the disease by making all HIV-positive people — whether they know it or not — potential criminals".

Also, the virus' long dormancy period would make it "almost impossible to trace the route of transmission", making the law moot, Dr Koe argued. And it was possible wives would not report their husbands for fear they might be prosecuted.

Madam Halimah Yacob, chairman of the Parliamentary Government Committee for Health, told Today these issues must be studied carefully before any legislation is implemented. But she thought the criminalising of patients who have sex without knowing that they are HIV-positive could apply "only for really severe cases" — that is, "if a person's lifestyle is so high-risk" that the person would suspect his or her condition even without medical confirmation.

Meanwhile, with males making up nine in 10 of the new HIV infections last year, the MOH will launch voluntary HIV testing for adult male inpatients.

Said Mr Khaw: "From the public health point of view, all persons who are HIV-infected should know their status. First, they can receive early treatment. Second, they can be counselled on how they can avoid infecting their loved ones."

This would also help ensure the safety of healthcare workers. A recent study revealed that 0.28 per cent of more than 3,000 anonymous blood samples collected in hospitals — from patients who thought themselves free of the disease — were, in fact, HIV-positive.

"Every day, we treat about 4,500 inpatients in public hospitals alone," said Mr Khaw. "If the hospital study is representative, then some 12 unknown HIV patients come into close contact with healthcare workers every day."

Leaving aside the practicalities of how to determine who gave HIV to whom touched on in the article, angry doc wonders how effective the proposed amendment to the law will help arrest the rising incidence of HIV infections in Singapore.Certainly legislation has an important role to play in public health control, but so do education, access to treatment, and support from the community.We have seen some success in controlling tuberculosis based on those principles and on the recognition that TB is not just an individual's problem, and that the control of TB will benefit the whole community. Why can't we apply the same thinking to HIV and AIDS?